Advanced Gynaecological Surgery Centre
 
Treatment Options

Vaginal Prolapse Repair Surgery

Your doctor has recommended a vaginal reconstructive procedure to treat your condition. The operation involves surgery to reattach the vagina to its original supports.
In some instances your doctor may suggest removal of the uterus as part of your operation to correct prolapse.

Definition of Prolapse

This term refers to weakness in vaginal supports which results in a protrusion of the vaginal wall(s). This is more likely to occur during activities which increase the pressure inside the abdomen and pelvic floor such as heavy lifting or straining, coughing or sitting on the toilet to pass a bowel action. This may result in a noticeable bulge, lump or dragging sensation in the vagina. The lump may be due to a weakness in the front, back or top of the vagina or a combination of all three.

Vaginal Prolapse Repair SurgeryThe bladder sits in front of the vagina, the bowel (rectum) sits behind the vaginaand the cervix and uterus lie at the top of the vagina.  A lump that comes out of the vagina can consist of one or more of these organs. This is why some people have trouble emptying their bladder or opening their bowels.

Occasionally prolapse can distort the anatomy causing obstruction to the urinary tract masking incontinence.  Surgery to repair a prolapse, in correcting this obstruction, may occasionally result in stress incontinence post operatively.  Sometimes a simple additional procedure to prevent this happening is performed at the same time.  Your specialist can discuss whether this might be appropriate for you.

Both prolapse and urinary incontinence are more common in women who have had children. It is thought that tissue damage due to childbirth worsens with age, leading to the gradual onset of prolapse symptoms.

Some women seem particularly prone to developing prolapse.

There are many surgical procedures that can correct your problem.

Your doctor will discuss various options with you to help you decide what is likely to be the best solution.

Types of procedures:            

Anterior and Posterior Repair (Front and back wall of the vagina)

  • This operation involves incisions inside the vagina which enables the surgeon to access the tissue supporting the vagina.  This tissue (fascia) is strengthened with stitches and reattached to the supporting structures within the pelvis.
  • This may involve the front or the back walls of the vagina or both, depending on the type of prolapse you have.
  • The incisions inside the vagina are then closed with stitches that will dissolve in a few weeks.
  • At the end of the operation a catheter will be placed into your bladder to drain urine and a gauze pack will be placed in the vagina to prevent bleeding.  These will remain in place for 1-2 days.  They are easily removed by the nursing staff.

Sacrospinous / Uterosacral ligament fixation

  • This operation is performed to elevate and support the top part of the vagina.
  • Usually 2 permanent stitches are placed into one or two tough fibrous structure known as the sacrospinous or uterosacral ligament. The stitches are then secured to the top of the vagina just beneath the skin.
  • Sometimes the procedure is done on both sides and usually performed along with one of the other procedures listed on this page.
  • This stitch may cause some temporary discomfort in the buttock which may persist for up to three months.

Laparoscopic Vault Suspension (for isolated uterine or vaginal vault prolapse)

  • From within the abdomen and using keyhole instruments, permanent stitches are placed between the top of the vagina and the supportive structures adjacent to it. 
  • This can be performed as a stand alone procedure or at the same time as a Total Laparoscopic Hysterectomy to correct vault prolapse. 
  • This approach allows good visualisation of the tissues to be repaired, does not involve opening the vagina (unless a hysterectomy is done at the same time) and avoids shortening or narrowing the vagina. 

Success Rates for Prolapse Surgery

It is generally believed that between 10-30% of women may require a second operation to treat prolapse in the future.

This may be due to the recurrence of an old prolapse or development of a new type of prolapse.

Complications after Surgery for Prolapse or Incontinence

These risks of surgery can be divided into general risks associated with any operation and risks specific to the surgery you are having.

General risks of surgery

These include Risk
  • Wound, chest or urinary tract infection,
2-11%
  • Major haemorrhage requiring blood transfusion,
1-4%
  • Blood clots in the legs or lungs
<1%
  • Risks of the anaesthetic including heart attacks or strokes.
<1%

Risks specific to prolapse or incontinence surgery

These include Risk
  • Injury to adjacent organs including,
    • Bowel or Ureter
    • Bladder
<1%
<1%
  • Pelvic haematoma (blood clot)
1-2%
  • Chronic Pelvic Pain
1-2%
  • Abnormal scarring of the vagina can also occur causing painful intercourse in approximately 2-7% and in rare cases make sex difficult or impossible.  This may be more common with Mesh augmentation.
  • When laparoscopic surgery is planned an open (abdominal) operation may occasionally be required to complete the surgery due to technical difficulties..
  • The above list is not exhaustive and does not include all possible risks

Length of stay in hospital

  • With a vaginal or laparoscopic pelvic floor repair surgery you will usually go home within 2-3 days of surgery.

Recovery

  • 6-8 weeks

  • Pelvic floor exercises, weight reduction may all reduce the incidence of recurrence of prolapse. 
  • These conservative measures alone may be enough to treat  prolapse symptoms.
  • Pelvic floor exercises should be taught and supervised by a physiotherapist who specialises in pelvic floor defects.
  • Ideally these should be initiated prior to having surgery to maximise your pelvic floor function and reduce the potential for recurrent prolapse.
  • Please speak to our reception staff for contact details or a referral.

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